Diagnostic prognosis. <ul><li>What are evaluations of the course of the disease without treatment ? </li></ul><ul><li>What is the status of the teeth now </li></ul><ul><li>What is the anticipated future of these teeth ? </li></ul>
Therapeutic prognosis. <ul><ul><li>Given the state of the art and science of periodontics and the knowledge and skill of the practitioner, what effect will periodontal treatment have on the course of the disease? </li></ul></ul>
Prosthetic prognosis. <ul><li>What is the forecast for the success of the prosthetic restoration? </li></ul><ul><li>Will the prosthesis be therapeutic or detrimental ? </li></ul><ul><li>What specific needs dictate that it be prescribed? </li></ul>
Judgement of the severity depends on ： <ul><li>1. pocket depth, </li></ul><ul><li>2. degree of bone loss, </li></ul><ul><li>3. tooth mobility, </li></ul><ul><li>4. crown-root ratio. </li></ul>
generalized or localized The distribution of disease ： Inflammatory factors ： Traumatic factors ：
Individual tooth therapeutic prognosis includes such factors as ： Percentage of bone loss; Probing depth ;
Distribution and type of bone loss Presence and severity of furcation involvements Mobility
Crown-root ratio Pulpal involvement Tooth position and occlusal Strategic value
Following are factors included in overall prognosis: <ul><li>Age </li></ul><ul><li>Medical status </li></ul>
Individual tooth prognoses (distribution and severity) Degree of involvement , duration, and history of the disease (rate of progression)
Patient cooperation Economic considerations Knowledge and ability of the dentist Etiologic factors
Accuracy and completeness of the information gathered at the examination Dentist's ability to recognize and eliminate or control the factors causing the disease
the patient's ability and determination in maintaining the health of the periodontium and teeth.
The overall prognosis depends on the prognoses of the individual teeth.
Treatment goals should be evaluated in every case.
Can treatment objectives of a firm non-retractable gingiva that does not bleed be reached? Can the pocket be eliminated? Will the bone regenerate? Can the tooth be stabilized?
Can tooth be restored? Can the patient tolerate the treatment?
If you believe the answers to these questions to be "yes," then plan and proceed with the treatment. If “no,” alternative treatment, compromise, or extraction is advisable.
As definitive laboratory tests are developed to make diagnosis more accurate , and as further knowledge concerning the etiology and pathogenesis of periodontal diseases is developed, prognosis will change from a qualitative to a quantitative judgment.
First steps (The initial effort) should be directed toward the elimination of inflammation and the institution of a program of plaque control.
To reduce pocket depth To minimize periodontal traumatism Orthodontics (may precede or follow any surgical interventions)
Extractions (Teeth with hopeless prognoses) Restorations Usually periodontal therapy should precede restorative interventions. the restorations should be temporary
The provisional splinting during the treatment period should be evaluated.
Scheduling of restorative treatment should be done according to the following general rules:
Normal patients. (Restorative treatment starts immediately.) Class I (ADA periodontal disease classification)
Without occlusal treatment need Caries control and scaling and root planning. including plaque control, may be simultaneous . Definitive restorative treatment should follow completion of scaling and plaque control.
With occlusal treatment need Definitive restorative treatment may immediately follow completion of scaling, plaque control, and occlusal adjustment .
With surgical treatment need Definitive restorative treatment should not be instituted for at least 4 to 6 weeks after the patient has healed .
Splinting (Wire ligation and composite acid-etch splinting) Emergency (pain, swelling, infection, and discomfort) The emergencies all take priority over other treatment scheduling.
Medical status a systemic condition that would complicate treatment, a medical consultation is necessary.
Maintenance therapy The specialist may see the patient once a year or every other year for the less involved cases, whereas the generalist maintains the patient in the recall system. Advanced cases may be seen alternately at 2- to 4-month intervals.
PROSTHETIC PRESCRIPTION Waiting for a period of at least 2 months after periodontal surgery. Partial dentures or a fixed prosthesis
Alternative treatment plans should be prepared for the patient who elects to forego splinting and surgery when these are indicated.
In this case the patient may be treated through phase I therapy and be placed on a maintenance schedule. The establishment of an alternative plan generally calls for a rigorous maintenance schedule with scaling and planing performed more frequently than is otherwise usual.
Quality of care In general, periodontal care seeks the following: Removal of known etiologic factors Reduction of all pockets to a minimal depth to facilitate maintenance by the patient and the dental hygienist Creation of a maintainable gingival and osseous architecture
Restoration of a functional and esthetic dentition Maintenance of the resulting health by the patient, doctor, and hygienist
periodontal diseases can be treated successfully the health of the diseased periodontium can be restored and the teeth maintained.
The therapeutic concept of today includes all forms of therapy, conservative and complex selected and blended for the successful management of the individual patient.
Therapy must be tailored to the needs, both physical and psychologic, of the patient.
RECORD KEEPING The treatment performed should be recorded carefully at each visit.
Referral There are three basic reasons for referral: (1) professional, (2) moral an ethical, and (3) legal.
Professional: Professional referrals are classified as follows: 1. Medical: Referral/consultation is indicated when a patient's medical history discloses significant information that may contribute to or influence the course and outcome of the treatment or when the dentist suspects illness.
2.Dental: Referral/consultation is indicated when the dentist cannot provide the entire dental therapy the patient needs. When the examination reveals periodontal disease that the generalist cannot or does not wish to treat, referral to a periodontist is in order. Equally the periodontist is obligated to refer patients for treatment to the general practitioner or other specialists.
3.Moral and ethical: <ul><li>The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or if none, to the dentist of record for future care. </li></ul>
The specialists shall be obligated when there is no referring dentist and upon a completion of their treatment to inform patients when there is a need for further dental care .
Other reasons for referral include: patient relocation, dentist-patient personality conflict, and dentist's preference. Some dentists do not use specialty , do not use specialty service
Communication Informing the patient about the disease condition; a recall-maintenance schedule should be made.
Documentation All communication, written or verbal, must be properly documented on the patient’s chart. Patients have the right of access to their records and may acquire copies of the original documents, not original documents.